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CITY OF ORONO PERMIT NO.: 2010-00966 <br /> �w <br /> 2750 KELLEY PARKWAY <br /> � ORONO, MN 55356- DATE ISSUED: 10/07/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3860 NORTH SHORE DR <br /> PIIv : 08-117-23-33-0095 <br /> LEGAL DESC : CRYSTAL BAY VIEW <br /> : LOT 000 BLOCK 007 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ROOFING-ASPHALT <br /> ACTIVITY : O/S BUILDING-LJNDEFINED <br /> VALUATION : $ 5,000.00 <br /> APPLICANT pERMIT FEE SCHEDULE 118.00 <br /> SIMMONS,BRETT STATE SURCHARGE(VALUATION) 5.00 <br /> 3860 NORTH SHORE DRIVE <br /> MOUND,MN 55364- MISC FEE 0.00 <br /> TOTAL 123.00 <br /> PAID WITH CC# 7249 <br /> OWNER <br /> SIMMONS,BRETT <br /> 3860 NORTH SHORE DRIVE <br /> MOLJND,MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and dces <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ���� /�J / �7 / /d / / <br /> Applicant Permitee gnature Date Issued By S' ature <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV <br />